Eligibility and Enrollment Flashcards
7 cards from real CACS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Eligibility and Enrollment flashcards as text
Which metal tier plan provides Cost-Sharing Reductions (CSRs) to eligible consumers?
Answer: Silver plans only
CSRs are only available on Silver plans; consumers with incomes between 100–250% FPL must enroll in a Silver plan to access CSR benefits.
A consumer's household includes herself, her spouse, and her two dependent children. Her teenage daughter is claimed as a dependent but files her own taxes. How is the household size counted for APTC eligibility?
Answer: 4 (all family members listed on the primary tax return)
Household size for APTC is based on the tax household—everyone claimed as a dependent counts, even if the dependent also files a separate return.
What happens if a consumer does not reconcile their APTC on their federal tax return?
Answer: They may be required to repay some or all of the APTC they received
Consumers must file IRS Form 8962 to reconcile APTC; failure to do so can result in repayment of excess credits and ineligibility for future APTCs.
A Native American/Alaska Native consumer enrolled in a Silver plan with income at 250% FPL. Which additional benefit may they be entitled to?
Answer: Zero cost-sharing for services from Indian Health Service and tribal providers
Native Americans and Alaska Natives enrolled in Marketplace plans can receive zero cost-sharing when using Indian Health Service, tribal, or urban Indian health providers regardless of income.
What is the primary purpose of the 'minimum value' standard for employer-sponsored health plans under the ACA?
Answer: To ensure plans cover at least 60% of the total allowed costs of benefits
A plan meets minimum value if it pays for at least 60% of the total allowed cost of plan benefits, similar to the actuarial value of a Bronze plan.
During Open Enrollment, a consumer selects a plan on November 20. What is her earliest possible coverage start date?
Answer: January 1 of the following year
For most Marketplace plans, coverage selected during Open Enrollment starts January 1 of the following plan year, not immediately.
A consumer earning 95% FPL lives in a non-expansion state. What Marketplace assistance may she qualify for?
Answer: She falls into the 'coverage gap' and may have no affordable option
In non-expansion states, consumers below 100% FPL are ineligible for Medicaid (if not otherwise eligible) and ineligible for APTC, leaving them in the 'coverage gap.'